Pakistan Earthquake Relief Update

January 3, 2006

Omar Amir

The Real Medicine Team formulated a set of basic pictorial guidelines about proper care for wounds arising from earthquake injuries, amputations and bed sores in the case of paraplegics. These guidelines are simple enough to be carried out by local dispensers/technicians, nurses and community health workers as well as the caregivers in patients' families and patients themselves. To go along with the guidelines, the team devised a basic kit for wound care from cheap materials available from local pharmacies. If purchased in bulk, the kits would cost about a dollar each. To demonstrate the guidelines and use of the wound care kit, the Real Medicine team conducted training sessions for dispensers/technicians at the Islamabad tent village for internally displaced victims and the Roomy Park Rehabilitation Center and Combined Military Hospital in Rawalpindi on January 3.

The guidelines and ideas for the kit evolved out of Dr. Giorgio Pietramaggiori's experiences in the field working with surgical teams at the Pakistan Institute for Medical Sciences (PIMS) and other hospitals in Islamabad as well as the Medicins Sans Frontiers (MSF) field hospital in Mansehra. Since so many surgeries had to be done soon after the earthquake and there was no possibility of follow-up, there are numerous cases of improperly healed bones and infected wounds. The great danger is that without proper wound care, victims can suffer severe infections and even lose their limbs. There is a great need for simple guidelines that can be understood and carried out easily by health workers, the families of victims or victims themselves to provide continuity of wound care. During various site visits, Dr. Giorgio, Omar Amir and Dr. Zahoor of HOAP Foundation also observed excessive use of iodine and other inappropriate wound care techniques that delayed healing or led to infections.

These guidelines and kits for wound care will be particularly important in areas like Shawal Moizullah, where HOAP and Real Medicine arefocusing their operations, since most people here live in villages more than 7000 ft above sea level and cannot frequently access healthcare facilities by coming down to the HOAP camp at Jabri. Here many patients with injuries may go a week without seeing a nurse or a technician and therefore would benefit from materials and guidelines that can be self administered. During the site visit to the HOAP camp at Jabri on January 1st, the Real Medicine Team saw a number of infected wounds arising out of improper care.

The Real Medicine Team discussed their findings about wound care in a meeting with the M. Naseer Khan, the Health Minister of Pakistan. The Ministry of Health will coordinate further workshops to be conducted by the Real Medicine and HOAP team at hospitals in Mansehra, Muzaffarabad (Kashmir) and Abottabad. Real Medicine and HOAP also discussed the project with the World Bank and have submitted a proposal for $5000 to conduct training workshops on preventing infected wounds in Jabri and other earthquake affected areas.  

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